Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.
Objective: Small business is a favorably regarded institution in America. Given employment disparities among individuals with psychiatric disabilities compared to other workers, self-employment has potential to promote career development and community integration. However, little is known about what has helped or hindered current small business owners with psychiatric disabilities. This exploratory study identified characteristics of individuals' work and disability histories, as well as business characteristics, that can inform policy and practice development in support of disability-owned small businesses. Method: A nonprobability sample of 60 U.S. adults with a history of psychiatric disability who were self-employed in 2017 completed a web-based survey that asked about demographics, experiences of disability, motivations for self-employment, and business characteristics. Results: Most survey respondents were operating new, very small, unincorporated home-based service businesses on a part-time basis. Respondents were educated, typically with extensive work histories, but had experienced discrimination and unpleasant attitudes from coworkers and supervisors. Responses highlighted the importance of freedom and work-life balance. Conclusions and Implications for Practice: Self-employment is not necessarily a fit for everyone, but for individuals with psychiatric disabilities, it may be a pathway back to work. The size of the respondent businesses and the part-time nature of the work suggests that individuals with psychiatric disabilities are operating very small businesses that may serve as a wage employment alternative if they are able to grow in the future, or be sustained as a part-time adjunct to public benefits or other paid or unpaid work. Impact and ImplicationsSelf-employment is one strategy to improve employment and financial outcomes for individuals with psychiatric disabilities while also promoting community inclusion. This research is an important first step in exploring self-employment among people with psychiatric disabilities so that others can learn about how it works. It shows that some self-employed individuals with psychiatric disabilities are running very small businesses part time, supplementing their income. They have had negative experiences in the workplace and have chosen self-employment seeking freedom, flexibility, and work-life balance.
Innovation within the NHS is vital to achieve two aims: firstly and most importantly: improving patient care; secondly saving money, to sustain our healthcare system.A “good death” was defined in 1997 by the Institute of Medicine as:“free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' families' wishes; and reasonably consistent with clinical, cultural, and ethical standards”.In England, some 1,300 people die every day. 60% of these people die in hospital but around 70% would prefer to die at home. Estimates suggest we spend about £55m each day on this failure to give people a good death.Nationally excellent work is happening to address these issues, and at Weston General we are pioneering in Palliative Care. As F1 doctors we have been working with the Palliative Care team to contribute to the improvements. Weston received a budget to employ specialist palliative care nurses trained by the local hospice to work in each ward of the hospital.We then put together a computer program allowing data from all deaths to be easily collated. This has allowed us to produce monthly palliative care reports to prove the impact of our new nurses and educate junior doctors on the importance of advanced care planning. We now have a tool that allows us to measure outcomes and monitor adherence to local and national policy regarding end of life care.With this knowledge comes the power to begin the change, to realise a “good death” for all patients. On our final report we found 51.5% of deaths in our area occurred in people's usual place of residence, the highest in the country. Compiled with other both quantitative and qualitative data we can prove Weston's innovations are striving towards giving people a “good death.”
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